Provider Demographics
NPI:1295930352
Name:KORIN, MARY ANNE - (CPTA)
Entity type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:-
Last Name:KORIN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3223
Mailing Address - Country:US
Mailing Address - Phone:845-628-6826
Mailing Address - Fax:
Practice Address - Street 1:584 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1522
Practice Address - Country:US
Practice Address - Phone:914-762-2222
Practice Address - Fax:914-762-9175
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004815-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant